Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction

Abstract

BackgroundStunting in early life has considerable human and economic costs. The purpose of the study was to identify factors associated with stunting among children aged 0-23 months in Indonesia to inform the design of appropriate policy and programme responses.MethodsDeterminants of child stunting, including severe stunting, were examined in three districts in Indonesia using data from a cross-sectional survey conducted in 2011. A total of 1366 children were included. The analysis used multiple logistic regression to determine unadjusted and adjusted odds ratios.ResultsThe prevalence of stunting and severe stunting was 28.4 % and 6.7 %, respectively. The multivariate analysis on determinants of stunting identified a significant interaction between household sanitary facility and household water treatment (P for interaction = 0.007) after controlling for potential covariates: in households that drank untreated water, the adjusted odds on child stunting was over three times higher if the household used a unimproved latrine (adjusted odds ratio 3.47, 95 % confidence interval 1.73-7.28, P <0.001); however, in households that drank treated water, the adjusted odds on child stunting was not significantly higher if the household used an unimproved latrine (adjusted odds ratio 1.27, 95 % confidence interval 0.99-1.63, P = 0.06). Other significant risk factors included male sex, older child age and lower wealth quintile. The risk factors for severe stunting included male sex, older child age, lower wealth quintile, no antenatal care in a health facility, and mother’s participation in decisions on what food was cooked in the household.ConclusionsThe combination of unimproved latrines and untreated drinking water was associated with an increased odds on stunting in Indonesia compared with improved conditions. Policies and programmes to address child stunting in Indonesia must consider water, sanitation and hygiene interventions. Operational research is needed to determine how best to converge and integrate water, sanitation and hygiene interventions into a broader multisectoral approach to reduce stunting in Indonesia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3339-8) contains supplementary material, which is available to authorized users.

A review of child stunting determinants in Indonesia

“…In a recent study, purchase of inexpensive drinking water—which was assumed to be untreated—was associated with increased odds of stunting in children 0–59 months in urban slums (UOR 1.32, 95% CI [1.20, 1.45]; Semba et al, ). Additionally, Torlesse, Cronin, Sebayang, and Nandy () analysed a cross‐sectional survey and demonstrated that children 0–23 months living in a household with untreated drinking water had much higher odds of stunting if the household also used an unimproved latrine (AOR 3.47, 95% CI [1.73, 7.28]). Food insecurity was associated with child stunting in one cross‐sectional study, which found lower odds of stunting (AOR 0.70, 95% CI [0.50, 0.99]) in children 0–23 months in households that consumed more than two meals a day (Ramli et al, ).…”

“…Similarly, Semba et al () reported decreased odds of stunting with higher household animal‐source food expenditure in rural children (UOR 0.87, 95% CI [0.82, 0.92]) and urban poor children (UOR 0.78, 95% CI [0.72, 0.85]) and decreased odds of stunting with higher household plant‐source food expenditure in rural children (UOR 0.79, 95% CI [0.74, 0.84]) and urban poor children (UOR 0.86, 95% CI [0.79, 0.94]) 6–59 months. In a recent study, households without age‐appropriate feeding—which includes a minimum acceptable diet of adequate diversity and frequency—were associated with increased odds of stunting in children 0–23 months (UOR 1.39, 95% CI [1.09, 1.77]; Torlesse et al, ).…”

“…The same studies also observed that prolonged breastfeeding was associated with a higher prevalence of child stunting, but there is insufficient evidence in this cross‐sectional study to determine a causal relationship and adequately account for confounding factors. As mentioned under inadequate complementary feeding, Torlesse et al () found a moderate association between age‐appropriate feeding—which also includes exclusive breastfeeding in children 0–5 months—and reduced child stunting (Torlesse et al, ).…”

“…Studies in Indonesia have addressed all determinants of health and health care except availability of supplies. Unsurprisingly, inadequate access to health care has been associated with child stunting in multiple studies (Anwar, Khomsan, Sukandar, Riyadi, & Mudjajanto, ; Bardosono et al, ; Torlesse et al, ). Bardosono et al () found an association between access to health services and HAZ, though the path‐model was a poor fit.…”

Hubungan Riwayat Penyakit Diare dan Praktik Higiene dengan Kejadian Stunting pada Balita Usia 24-59 Bulan di Wilayah Kerja Puskesmas Simolawang, Surabaya

“…Sebuah penelitian menjelaskan bahwa prilaku higiene yang baik yang dilakukan ibu atau pengasuh alita dapat memberikan efek protektif terhadap kejadian stunting [29] .…”